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A new PwC Health Research Institute report notes that while strides are being made in population health, many organizations struggle to scale efforts.
While the healthcare industry has made strides with population health, many organizations still struggle to scale their efforts, according to a new report.
Most efforts to date have been narrow-focused on a single group of patients with the same disease living in the same geography, according to PwC’s Health Research Institute’s "Population health: Scaling up."
“Our research suggests that for these programs to flourish, they will need more sophisticated analytics, patient stratification, community involvement and care management,” says Sarah Haflett, senior manager at PwC’s Health Research Institute.
With the increasing emphasis of public and private payers on value-based reimbursement, healthcare organizations will inevitably take on more risk in payment contracts, says Haflett.
“Organizations that can show evidence that their population health programs are working well on a large scale-across multiple diseases, geographies and the continuum of care-are more likely to be rewarded in these deals,” she says. “Scaling population health programs is essential to delivering quality outcomes while reducing spending. Managed care executives are integral to negotiating desirable payment contracts with public and private insurers as well as directly with employers.”
To scale their programs successfully and achieve better outcomes at a lower cost, health systems must address “whole health” needs that are medical, social and environmental, according to the report.
“Yet, we found that most primary care physicians are unprepared to manage patients' social or behavioral needs or coordinate with the right community-based resources,” Haflett says.
“Population health providers need to build an ecosystem of care and support services that extends into the community-and into the home-by establishing partnerships with organizations that can fill their service gaps and extend their reach to patients,” she says.
One example is the Center for Health Equity and Community Engaged Research at The Icahn School of Medicine at Mount Sinai in New York City. The mission is to improve the health and health care of underserved populations by identifying causes of disparities in health and healthcare, developing and testing community-partnered, sustainable interventions and disseminating lessons learned to inform policy and systems change.
Haflett offers this advice:
• Establish the funding mechanism for population health; design a payer strategy to manage risk and sustain operations.
“We see some providers partnering with insurers to outsource activities such as risk score optimization, actuarial analysis and claims administration,” Haflett says. “We see others that are on their way to becoming licensed health plans, which is a growing trend in a value-based health economy-our survey research has shown that about half of providers are considering this strategy.”
• Plan for early losses in your population health programs due to the heavy upfront investment in infrastructure that these programs require, and then contract accordingly.
“Structure partnership contracts with other care providers and community resources so that risk is shared appropriately among all partners in your population health delivery networks. In the early years, consider a shared-savings model in which dollars saved are divided into bonus payments, operational reinvestments and patient engagement incentives,” Haflett says.
“As you scale, you will be better positioned to take on more risk for the populations they serve,” she continues. “Having strong service level agreements with partners that are actively monitored and enforced will be critical to adequately managing risk."